Background: Accurate diagnosis of exudate pleural effusion is definitely important. Few studies have been published on this topic. The current work present evidence for the importance of the pleural fluid markers like high sensitivity-C reactive protein [hsCRP]; tumor necrosis factor alpha [TNFα]; and cholesterol levels measurement in differentiating types of exudative from transudative pleural effusion.
Aim: The current study was to determine and evaluate the diagnostic importance of measured levels of pleural fluid cholesterol, high sensitivity-CRP and tumor necrosis factorα in diagnosing and differentiating transudate from exudate pleural effusion.
Methods: This study was carried out on 100 patients suffering from pleural effusion who subjected to diagnostic evaluation at Al Sahel Teaching Hospital. The full biochemical analysis of the pleural fluid, pleural fluid culture, and cytology examination were also performed. TNFα, hs CRP, and cholesterol level were assessed in the samples of pleural fluid.

Results: One hundred patients were initially evaluated, in accordance to Light's criteria, of 100 patients suffering from pleural effusion, 67 had exudative effusions while 33 patients had transudative pleural effusion. The concentrations of pleural fluid hs CRP and TNFα, found to be significantly elevated in the exudative nature group of pleural fluid than the transudative pleural effusion group (p < 0.05). Also, pleural fluid cholesterol level was elevated in the exudative pleural effusion than transudative pleural effusion (P< 0.001).

Conclusion: Patients presented with pleural effusion, simple markers of elevated pleural fluid hsCRP, TNFα, and cholesterol levels may be helpful in discrimination between exudates and transudates effusion.